Nursing and the Unlimited Possibilities

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Describe the importance of nurses understanding the different types of white blood cells. Each of the blood’s components perform specific vital functions . Therefore nurses need to understand the roles these components play in order to assess, and identify normal, and abnormal lab values as well as their function when providing care and thus saving patients’ lives. In the clinical area where I practice, nurses have to monitor critical lab values results.

The communication is timed and the results must be communicated to the ordering physician within 30 minutes of the time the results are known in order to meet national patient safety and compliance standards. White blood cells (WBC) or leukocytes are whole cells with normal levels being 5000 – 10000/µl. They protect the body against harmful bacteria and infection. They increase for example not only in acute infection but trauma, and malignant diseases. They decrease, for example in immunosuppression , in anemia and diabetes mellitus.

An elevated white blood count (leukocytosis ) above 10000/µl can indicate inflammation or infection. It is a normal protective response to stresses such as invading microbes ( Tortora & Derrickson, 2006, p 677 ) . When white blood count is low ( leukopenia ), below 5000/µl, causes may be from systemic shock, radiation therapy, and chemotherapeutic agents. With a abnormal low neutrophil count (neutropenia ) the patient may be at risk for infection and have potential to get septecemia.

In my clinical area of practice the patient is placed on neutropenic precautions where reverse isolation is done to protect the patient from others. Blood, urine, sputum, and wound cultures are ordered and specimens sent to the lab by nurses. After specimens are collected the patient is started on gram negative and gram positive antibiotic until culture and sensitivity results are available. White blood cells are classified in two ways. These are: 1. Granular leukocytes: for example, basophils, neutrophils, and eosinophils. 2. Agranular leukocytes: for example, lymphocytes and monocytes.

When a physician orders differential WBCs count this is a count, of each of the five types of WBCs. Nurses know that this test result will show the percentage of each type in the blood or any abnormal or immature cells. This aids in diagnosing a patient’s condition. The WBC panel summary can be reviewed below: WBC Group /Normal Range Implication of Abnormal Values WBC Functionality |Neutrophils : 40% – 60% | -High count may indicate bacterial infection, |Surround and digest invading organisms and | | |inflammation, acute infection, rheumatoid |other foreign matter through phagocytosis .

| | |arthritis, rheumatic fever. | | | |-Low count may indicate drug toxicity, SLE, | | | |radiation exposure, Vit. B12 deficiency, | | | |aplastic anemia | | |Lymphocytes: 20% – 40% |-High count may indicate viral infections, some|Lymphocytes respond to antigens and combats | | |leukemias, infectious hepatitis ,chronic |infection through the body’s antigen-antibody | | |bacterial infection. |response, to provide immunity. | | |-Low counts may indicate immunosuppression, HIV| | | |infection, and sepsis.

| | |Monocytes : 2% – 8% |-High counts may indicate viral or fungal |Monocytes along with neutrophils destroy | | |infections, Tb, Leukemias |invading organisms by phagocytosis | | |-Low counts may indicate bone marrow | | | |suppression, treatment with cortisol | | |Eosinophils : 1% – 4% |- High counts may indicate allergic reactions, |Defend the body against parasites, allergic | | |parasitic infections, autoimmune diseases, |reactions, and fight lung and skin infections | | |cancers. | | | |- Low counts may indicate drug | | | |toxicity,stress.

| | |Basophils : . 05% -1 % |- High counts may indicate allergic reactions, |Release heparin , histamine , and serotonin in | | |leukemias, cancers ,hypothyroidism |allergic reactions that increase the | | |- Low counts may indicate pregnancy, ovulation,|inflammatory response. | | |hyperthyroidism,stress | | Implication and Nursing Considerations When there is a diagnosis of leukocytosis or leukopenia nurses know that further investigations to evaluate and treat the patient will be required.

If the patient has signs and symptoms of infection and the leukocytosis is persistent and unresponsive to antibiotic therapy then the nurse knows that the Physician will have to be notified and he/she will order consultation for Infectious Disease to manage and treat persistent leukocytosis. Nurses also know that they need to administer ordered antibiotic therapy in the correct dose and at the correct time to fight the infection. When there is a diagnosis of leukopenia this may suggest immunosuppression, so if the physician for example orders HIV testing then nurses know that they have to get consent from the patient.

Nurses also know that it is important to understand the different types of white blood cells so they can educate their patients about normal and abnormal lab results and required treatment plans.

References: Dugdale D. C. , III, MD, & Zieve D. , MD, MHA. (2/13/2011). Blood Differential. Retrieved from http://www. nlm. nih. gov/medlineplus/ency/article/003657. htm Tortora,G. J. & Derrickson ,B. (2006) Principles of Anatomy & Physiology ( 11th ed. ).

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